Incidence of obesity, overweight and hypertension in children and adolescents in Ahvaz southwest of IRAN: Five-years study

OBJECTIVE

The purpose of this study was to investigate the incidence of obesity, overweight and hypertension in children and adolescents aged 10-15 in Ahvaz.

METHODS

This is a epidemiologic study performed on 176 people aged 10-15 in Ahvaz. In 2009, 300 people underwent weight, height and blood pressure measurements. Five years later, the same people were reassessed for obesity, overweight and hypertension, of whom a total of 176 people agreed to repeat the procedure.

RESULTS

The study included 100 (57%) males and 76 (43%) females. Mean BMI was 22.1 ± 4.3 kg / m2 in year 2014, without any significant difference between the two sexes (P = 0.518). In the same year, the prevalence of obesity and overweight was 26 (14.8%) and 13 (7.4%), respectively. After 5years, BMI increased significantly (P < 0.001). Of the 150 norma participants with normal BMI in 2009, 15 (10%) and 6 (4%) became overweight and obese in 2014 respectively. The mean systolic and diastolic blood pressures increased significantly over 5 years P = 0.042 and P < 0.001.

CONCLUSIONS

This study shows an increase in mean BMI and mean systolic and diastolic blood pressures after 5 years among people aged 10-15 in Ahvaz.

Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: a double-blind placebo-controlled randomized clinical trial

BACKGROUND

Lipid-lowering effect of Rhus coriaria L. (Rhus) has been investigated in multiple animal studies with promising results. Nonetheless, its clinical efficacy has not been adequately examined.

OBJECTIVE

The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyperlipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks.

MAIN OUTCOME MEASURES

The serum lipid levels, apolipoprotein-A1 (Apo-A1) and apolipoprotein-B (Apo-B) were measured.

RESULTS

Mean serum high-density lipoprotein cholesterol (HDL-C) and Apo-A1 levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention (P = 0.001). The analysis of covariance test including age, gender, body mass index (BMI), and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipoprotein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients (BMI ≥ 30 kg/m²).

CONCLUSION

The study showed significant increases in HDL-C and Apo-A1 levels in response to Rhus supplementation in patients with hyperlipidemia.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02295293.

Household cardiovascular screening of high-risk families: a school-based study

BACKGROUND

A parental history of cardiovascular disease has a strong relationship with risk factor clusters in the offspring. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in both high and low-risk families.

DESIGN

A school-based, cross-sectional study.

METHODS

The middle schools of the 6th district of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group and 105 low-risk children with their families were recruited from the second group of schools. Anthropometric and metabolic measurements were performed.

RESULTS

The means of the waist circumference and waist-to-hip ratio were significantly higher in high-risk fathers. The means of total and low-density lipoprotein (LDL) cholesterol were significantly higher in both parents and children of the high-risk group. The means of the fasting plasma glucose were significantly higher in fathers and offspring of high-risk families. More fathers in high-risk families were smokers. The prevalence of increased total cholesterol, LDL-cholesterol and hyperglycemia (> or = 100 mg/dl) were higher in high-risk parents and children. The prevalence of increased body mass index (> or = 25 kg/m for parents and 85th percentile for children) was higher in fathers and children of high-risk families.

CONCLUSIONS

Cardiovascular risk factors are more prevalent and clustered in high-risk families. The screening of high-risk families is essential to prevent the progression of atherosclerosis from childhood and reduce the burden of cardiovascular disease in adulthood.

A Systematic Review of Studies on Blood Pressure in Iranian Pediatric Population: First Report From the Middle East and North Africa

Context:

Blood pressure (BP) tracks from childhood to adulthood, and has ethnic variations. Therefore, it is important to assess the situation of pediatric BP in different populations. This study aims to systematically review the studies conducted on BP in Iranian children and adolescents.

Evidence Acquisition:

We conducted a systematic review on published and national data about pediatric BP in Iran, our search was conducted in Pub Med, Medline, ISI, and Scopus, as well as in national databases including Scientific Information database (SID), IranMedex and Irandoc from 1990 to 2014.

Results:

We found 1373 records in the primary search including 840 from international and 533 from national databases. After selection and quality assessment phases, data were extracted from 36 papers and four national data sources. Mean systolic BP (SBP) varied from 90.1 ± 14 mmHg (95% CI 89.25, 90.94) to 120.2 ± 12.3 (118.98, 121.41) mmHg, and for diastolic BP (DBP) from 50.7 ± 11.4 (50.01, 51.38) to 79.2 ± 12.3 (77.95, 80.44) mmHg. The frequency of elevated BP had large variation in sub-national studies with rates as low as 0.4% (0.009, 1.98) for high SBP and as high as 24.1% (20.8, 27.67) for high DBP. At national level, three surveys reported slightly raised rates of elevated BP from 2009 to 2012.

Conclusions:

The findings provide practical information on BP levels in Iranian pediatric population. Although differences exist on the findings of various studies, this review underscores the necessity of tracking BP from childhood, and implementing interventions for primordial prevention of hypertension.

Assessing and Comparing the Short-Term Effects of TPB Only and TPB plus Implementation Intentions Interventions on Snacking Behavior in Iranian Adolescent Girls: A Cluster Randomized Trial

Purpose.

The evidence for the effectiveness of theory of planned behavior (TPB)–based interventions is mixed. There is also mixed evidence on the effectiveness of adding implementation intentions to TPB-based interventions. In this study we assessed and compared the short-term effects of TPB-only intervention and TPB plus implementation intentions intervention on snacking behavior and intention to consume unhealthy snacks in Iranian adolescent girls.

Design.

Three-arm cluster randomized controlled trial.

Setting.

Ten middle schools in Tehran (Iran).

Subjects.

A total of 29 classes included 739 female adolescents (age range: 12–15 years).

Intervention.

Two brief interventions including TPB-only intervention and TPB plus implementation intentions intervention.

Measures.

Food frequency questionnaire and intentions at baseline, 10 days, and 3 months measuring snacking behavior and cognitions about unhealthy snack consumption, respectively.

Analysis.

Hierarchical linear modeling to assess the interventions' effects.

Results.

Both interventions successfully decreased intention to consume and consumption of unhealthy snacks at postintervention. Calculation of the effect sizes revealed that the TPB plus implementation intentions intervention was more effective than the TPB-only intervention. The effects remained significant at 3-month follow-up in the TPB plus implementation intentions intervention group only, although the effect size decreased.

Conclusion.

Overall, the study suggests that adding implementation intentions on top of TPB-based persuasive messages improves effectiveness and sustainability of desirable changes.

Evaluation of carotid calcification detected using panoramic radiography and carotid Doppler sonography in patients with and without coronary artery disease

OBJECTIVES

Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings.

METHODS

Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries.

RESULTS

The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confirmed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak.

CONCLUSION

Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.

Cord blood lipid profile in a population of Iranian term newborns

Premature coronary artery disease (CAD) and its risk factors are highly prevalent in Iran. It is well documented that atherosclerosis starts in childhood and there is evidence that this association with adult levels may originate at birth, so assessment of serum lipid levels in neonates might be of importance. In this study we aimed to measure serum lipoprotein and apolipoprotein levels in a representative sample of Iranian newborns. Cord blood lipid profile, apolipoprotein A, apolipoprotein B, and lipoprotein a (LPa) were analyzed in 378 full-term, Iranian newborns. The mean values of total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, and Lpa in girls were 81.4 +/- 28.3, 35.9 +/- 22.4, 31.1 +/- 9.9, 87.9 +/- 20.2, 34.2 +/- 18.2, and 21.0 +/- 2.8 mg/dL, respectively; these values in boys were 75.2 +/- 21.1, 32.1 +/- 16.3, 28.8 +/- 8.7, 84.3 +/- 16.0, 32.6 +/- 14.2, and 19.5 +/- 2.7 mg/dL, respectively. Median values of triglycerides (TGs) in boys and girls were 61 and 62 mg/dL, respectively. Female neonates had significantly higher concentrations of TC and HDL-C than males (81.4 +/- 28.3 vs. 75.2 +/- 21.1, p = 0.02, and 31.18 +/- 9.97 vs. 28.8 +/- 8.7, p = 0.02, respectively). Other biochemical factors were not significantly different between genders. The mean and median concentrations of LPa were 20.3 and 18.7 mg/dL, respectively, which are almost five times higher than those reported in some other studies. The TG concentration was 1.5-2 times higher than those previously reported. Our findings indicate that serum concentrations of LPa and TG in Iranian neonates are higher than those in previous studies; this disorder, which is likely placing Iranians at increased risk for future CADs, needs to be assessed in longitudinal studies.

Intrafamilial associations of lipid profiles and the role of nutrition: the Tehran lipid and glucose study

BACKGROUND

The role of gene and environment in the genesis of abnormal lipid profile is still a controversial issue.

OBJECTIVE

To clarify the importance of certain parental risk factors associated with lipid profiles of children and adolescents.

METHODS

We conducted this cross-sectional population-based study in district 13 in the east of metropolitan Tehran. One hundred and thirteen eligible families comprising 455 subjects (including 229 offspring, aged 5-25 years) were enrolled into the study. Anthropometric data were measured using a standard protocol. To measure lipid profiles, venous blood was obtained in the morning after the subjects had fasted for 12-14 h overnight. Dietary intakes were assessed by means of a 2-day dietary recall questionnaire.

RESULTS

The chances of having elevated serum total cholesterol were higher in sons of fathers with high cholesterol intake (OR = 3.1; CI = 1.1-9.2) and mothers with high saturated fatty acid (SFA) intake (3.4; 1.1-10.8). Positive correlations were seen between the energy intake of fathers and serum total cholesterol of their daughters (r = 0.34, p < 0.01); between the SFA intake of fathers and serum triglycerides (TGs) of their sons (0.29, p < 0.01) and between mothers' body mass index and daughters' serum TGs (0.23, p < 0.03). The chances of having low serum high-density lipoprotein cholesterol were lower in sons of mothers with high carbohydrate intake (11.0; 2.8-42.8) and mothers with high serum high-density lipoprotein cholesterol (6.8; 1.7-27.0). There were higher chances of having elevated serum low-density lipoprotein cholesterol in sons with fathers having high SFA intake (4.5; 1.4-14.3), with mothers having high serum TGs (6.1; 1.3-29.0) and with mothers having high cholesterol intake (4.3; 1.2-15.2).

CONCLUSION

The results indicate independent associations between diet contents and the lipid profiles of parents and their offspring as well as between lipid profiles and diet contents among spouses.

Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study

BACKGROUND

This study was conducted to assess the national prevalence of different grades of nutritional status (underweight, normal weight, overweight and obesity) among Iranian school-students and to compare the prevalence of overweight and obesity using three different sets of criteria.

METHODS

This cross-sectional national survey was conducted on a representative sample of 21 111 school students including 10 253 boys (48.6%) and 10 858 girls (51.4%) aged 6-18 years, selected by multistage random cluster sampling from urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran The percentage of subjects in the corresponding body mass index (BMI) categories of the Centers of Disease Control and Prevention (CDC), the International Obesity Task Force (IOTF) and the obtained national percentiles were assessed and compared.

RESULTS

There was no gender differences in BMI, but was higher in boys living in urban than in rural areas (18.4 +/- 3.88 vs. 17.86 +/- 3.66 kg/m(2) respectively, P < 0.05). The prevalence of underweight was 13.9% (8.1% of boys and 5.7% of girls) according to the CDC percentiles, and 5% (2.6% of boys and 2.4% of girls) according to the obtained percentiles. According to the CDC, IOTF and national cut-offs, the prevalence of overweight was 8.82%, 11.3% and 10.1% respectively; and the prevalence of obesity was 4.5%, 2.9% and 4.79% respectively. The prevalence of overweight was highest (10.98%) in the 12-year-old group and that of obesity (7.81%) in the 6-year-old group. The kappa correlation coefficient was 0.71 between the CDC and IOTF criteria, 0.64 between IOTF and national cut-offs, and 0.77 between CDC and national cut-offs.

CONCLUSIONS

The findings of this study warrant the necessity of paying special attention to monitoring of the time trends in child obesity based on uniform definitions, as well as to design programmes to prevent and control associated factors.

Trends in body mass index, blood pressure and parental smoking habits in middle socio-economic level Turkish adolescents

Patterns of cardiovascular risk factors in populations are not static over time. We examined trends in body mass index (BMI), parental smoking and blood pressure over a 15-year period in Turkish children aged 15-17 years. Two cross-sectional studies were performed in secondary schools in Turkey in 1989-1990 and 2004-2005. Study participants were 673 children in 1989-1990 and 640 adolescents in 2004-2005. Main outcome measures were weight, height, BMI, presence and amount of parental smoking, systolic and diastolic blood pressure. Age and sex matched comparisons were performed to assess temporal trends in these measures. Children in 2004-2005 had increased weight, height, BMI and decreased systolic and diastolic blood pressure in all age groups compared with children in 1989-1990. According to the international criteria, 3.4% of children were obese and 15.8% were overweight in 2005, compared to 0.7% obese and 4.2% overweight in 1990 (P<0.001). However, a decrease was noted in blood pressure; 16% were classified as hypertensive in 1989-1990 versus 8% in 2004-2005 (P<0.001). The prevalence and amount of parental smoking also decreased over the last 15 years. We observed significant changes in BMI and blood pressure in Turkish children over the last 15 years. Temporal trends in these parameters may indicate a change in the pattern of cardiovascular disease in this population.

Is family history of premature cardiovascular diseases appropriate for detection of dyslipidemic children in population-based preventive medicine programs? CASPIAN study

The objectives of this study were to determine the prevalence of dyslipidemia and the usefulness of self-report family history (FH) of premature cardiovascular disease (CVD) for identifying children with lipid disorders. This study was conducted on a representative, population-based sample of 4811 Iranian children and adolescents (2248 boys and 2563 girls) aged 6-18 years. We compared the obtained serum lipid profile with that of the Lipid Research Clinic (LRC) and calculated the predictive value of FH for detecting those children with dyslipidemia.Overall, for both genders and for age groups, the mean serum triglycerides (TG) and its percentiles were significantly higher, and the mean and percentiles of total, low-density, and high-density cholesterol (TC, LDL-C, and HDL-C respectively) were significantly lower than the LRC values. In total, 45.7% of participants had dyslipidemia; the most frequent ones were low HDL-C (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL-C (6.3%), respectively. The mean serum lipid levels and the anthropometric measures were not significantly different among those with or without positive FH. The sensitivity, and specificity, positive and negative predictive values for FH in detecting those children with dyslipidemia were 28.4, 70.3. 44.7, and 53.8%, respectively. The usefulness of FH in identifying dyslipidemic children was relatively low. The common lipid disorders in our community were the components of the metabolic syndrome. We suggest that the current guidelines for screening lipid disorders in youths, which are based on cholesterol, should consider such ethnic differences.

Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program - Heart Health Promotion from Childhood

OBJECTIVE

To evaluate the prevalence of overweight and obesity among Iranian adolescents and their relationship with modifiable environmental factors.

METHODS

The subjects of the present study were 1000 girls and 1000 boys, aged between 11 and 18 years selected by multistage random sampling, their parents (n = 2000) and their school staff (n = 500 subjects) in urban and rural areas of two provinces in Iran. Data concerning body mass index (BMI), nutrition and the physical activity of the subjects were analyzed by SPSSV10/Win software.

RESULTS

The prevalence of 85th percentile </= body mass index (BMI) < 95th percentile and BMI > 95th percentile in girls was significantly higher than boys (10.7 +/- 1.1 and 2.9 +/- 0.1%vs 7.4 +/- 0.9 and 1.9 +/- 0.1%, respectively; P < 0.05). The mean BMI value was significantly different between urban and rural areas (25.4 +/- 5.2 vs 23.2 +/- 7.1 kg/m2, respectively; P < 0.05). A BMI> 85th percentile was more prevalent in families with an average income than in high-income families (9.3 +/- 1.7 vs 7.2 +/- 1.4%, respectively; P < 0.05) and in those with lower-educated mothers (9.2 +/- 2.1 vs 11.5 +/- 2.4 years of mothers education, respectively). The mean total energy intake was not different between overweight or obese and normal-weight subjects (1825 +/- 90 vs 1815 +/- 85 kCal, respectively; P > 0.05), but the percentage of energy derived from carbo-hydrates was significantly higher in the former group compared with the latter (69.4 vs 63.2%, respectively; P < 0.05). Regular extracurricular sports activities were significantly lower and the time spent watching tele-vision was significantly higher in overweight or obese than non-obese subjects (time spent watching telelvision: 300 +/- 20 vs 240 +/- 30 min/day, P < 0.05). A significant linear association was shown between the frequency of consumption of rice, bread, pasta, fast foods and fat/salty snacks and BMI (beta = 0.05-0.06; P < 0.05). A significant correlation was shown between BMI percentiles and serum triglyceride, high-density lipoprotein-cholesterol and systolic blood pressure (Pearson's r = 0.38, -0.32 and 0.47, respectively).

CONCLUSIONS

Enhanced efforts to prevent and control overweight from childhood is a critical national priority, even in developing countries. To be successful, social, cultural and economic influences should be considered.

Oxidized LDL metabolites with high family risk for premature cardiovascular disease

OBJECTIVE

Considering the importance of primary prevention of Cardiovascular Disease (CVD) from childhood, especially in children with high family risk for premature atherosclerosis, and also the importance of oxidized LDL in the process of atherosclerosis, the main metabolites of ox-LDL i.e. Malondialdehyde (MDA) and Conjugated diene (CDE) have been measured in children of high risk families and compared with a control group.

METHODS

Children and adolescents (6-18 years) of parents with premature myocardial infarction (MI < or = 55 y in men and < or = 65 y in women), were selected as the case group. The control group included neighbors of the case group matched for age and socioeconomic status. All samples have been selected by simple random sampling. Both the case and control groups were divided in two subgroups: those with a total cholesterol and/or LDL-C > or = 95th centile and those with normal lipid levels. Each subgroup consisted of 32 subjects, so 128 subjects were studied (64 in the case and 64 in the control group). MDA and CDE were measured by spectrophotometry using molar absorbivity. Data were analyzed by SPSSv10/Win software using ANOVA, Bonferroni, Scheffe-Duncan, Tukey-HSD, and the Student's t-test.

RESULT

The mean MDA value in the case and control groups was significantly different (1.84 +/- 0.43 vs. 1.67 +/- 0.41 micromol/L, p=0.03), but this difference was not significant regarding the mean CDE level (0.50 +/- 0.05 vs. 0.47 +/- 0.04 micromol/L, p>0.05). The mean MDA level in the case group with hyperlipidemia was significantly higher than that in the case group without hyperlipidemia (1.985 +/- 0.516 vs. 1.690 +/- 0.366, micromol/L, P=0.02) and also higher than control group with or without hyperlipidemia (1.985 +/- 0.516 vs. 1.720 +/- 0.389, 1.615 +/- 0.429 micromol/L respectively, P<0.05). The mean CDE level in the case group with hyperlipidemia was significantly higher than the case group without hyperlipidemia (0.542 +/- 0.034 vs. 0.494 +/- 0.049 micromol/L, P=0.04) and higher than the control group with or without hyperlipidemia (0.542 +/- 0.034 vs. 0.464 +/- 0.051, 0.484 +/- 0.048 micromol/L respectively, p<0.05). In case boys with hyperlipidemia, the mean MDA (2.03 +/- 0.2 micromol/L) and the mean of CDE (0.56 +/- 0.04 micromol/L) was significantly higher than other subgroups (P<0.05).

CONCLUSION

Considering the increased susceptibility of LDL to oxidation in children with high family risk for premature CVD, special attention should be paid to consumption of foods and seasoning containing antioxidants from childhood especially in high risk families.

Zinc and copper status in children with high family risk of premature cardiovascular disease

BACKGROUND

Zinc and copper are beneficial to health, growth and development, and also for the prevention of cardiovascular disease (CVD) with regards to improved dietary habits as a preliminary step in CVD prevention. This study was conducted among 2-18-year-old children with high family risk of premature CVD in comparison to controls.

SUBJECTS AND METHODS

One hundred randomly selected children whose parents had premature myocardial infarction were included in the study. The controls were 100 individuals randomly selected from the case group's neighbors and matched for age, sex, and socioeconomic status. A four-day food record questionnaire was used to assess zinc and copper intakes, and their serum levels were determined using Flame-Atomic Absorption Spectrophotometry. The data were analyzed by SPSS/Windows V6 software, using the Student's t and Mantel-Hanzel tests. Significance of differences was considered at P<0.05.

RESULTS

The daily zinc intake was significantly lower in the case than control group (6.89+/-2.97 vs. 8.30+/-2.45 mg, P=0.047). The mean serum zinc level was not significantly different between both groups (82.12+/-14.1 vs. 92.26+/-23.7 microg/dL, P>0.05). Zinc deficiency was more prevalent among the case in boys than their controls (58% vs. 18%, P=0.04). This difference was not significantly in girls (44% vs. 40%). The daily intake and serum level of copper were not significantly different between the case and control groups. No case of copper deficiency was found. The mean systolic blood pressure was not significantly different between the zinc-deficient and zinc-sufficient subjects. Although the mean diastolic blood pressure of the former was higher than the latter, there was no statistically significant difference. About 23.7% of all studied sample had mild-to-moderate degrees of failure to thrive, with significantly lower daily intake and serum zinc level than other subjects (5.14+/-1.06 mg, 82.09+/-12.74 microg/dL vs. 6.89+/-2.14 mg, 99.25+/-27.15 microg/dL, respectively, P<0.05).

CONCLUSION

It is recommended that emphasis be placed on the consumption of food rich in zinc by children, especially those with high family risk of premature CVD.